DEPRIVED patients who repeatedly miss GP appointments should be targeted for same-day slots instead to increase their chances of attending, researchers have said.

The largest ever study into GP missed appointments in Scotland found that the poorest patients, especially those aged over 90 or between 16 and 30, were "significantly more likely to miss multiple appointments" than the average. It is thought transport was a factor hindering elderly patients.

Missed appointments were also higher at urban GP practices in more affluent postcodes where patients typically have to wait two to three days to see a doctor.

The study, published in the journal Lancet Public Health, said that poorer patients living in these areas were at particularly high risk of deteriorating health, either as a result of skipping routine check-ups to monitor chronic conditions or failing to attend appointments that would flag up a serious health problem earlier such as screening.

The report said appointment delays in these areas could "selectively disadvantage sick patients who are less able to negotiate earlier appointments", with a knock-on effect on their own health and "potential impacts on other emergency services".

In comparison, better-off "worried well" patients with minor ailments, but who are more articulate and demanding, are more likely swamp surgeries.

The researchers said: "There might be a case for some practices selectively offering on-the-day appointments for patients at high risk of serial non-attendance.

"Practices in more affluent areas seem to be more poorly equipped to accommodate patients who repeatedly miss multiple appointments than practices in more deprived areas and could benefit most from similar adaptations to their existing appointment systems.

"Practices with a higher proportion of socio-economically deprived patients might already have adjusted services accordingly...Our results suggest that socio-economically deprived patients living in more affluent areas might have particularly high levels of unmet health need in primary-care settings."

The study, led by researchers at GlasgowUniversity in collaboration with Aberdeen and Lancaster universities, is based on more than 13 million appointments from more than 100 general practices in 11 out of 14 health board areas over a three year period to 2016.

It found that nearly 20 per cent of patients missed more than two appointments over a three-year period, and 46 per cent of patients missed one or more appointments per year.

Some family doctors have previously called for patients to be charged for missing appointments in order to crackdown on non-attendance. A flat fee to see a GP, similar to the cost of a routine NHS dentist check-up, has also been mooted.

However, Dr Margaret Craig, a GP in Possilpark and Springburn who is a member of Scotland's 'Deep End' network of deprived area practices, said fees and penalties would create "even more of a barrier" and "make care even less accessible to those who really need it".

She said: "Missed appointments are a big problem. In our practice, if someone misses an appointment we'll be phoning them and follow-up why the appointment was made in the first place. Usually something's happened. They have other things that suddenly take over - social problems, mental health problems, physical problems, and the combination becomes overwhelming for people."

She welcomed the suggestion of prioritising same-day appointments to those at most risk of no-shows.

She said: "It would be good to find ways to make that work. It's just trying to work out how practically that could be done in a system that's overstretched."

Dr Andrea Williamson, lead author of the study, said: “Our work in this study is based on the theory that serial missed appointments are ‘health harming behaviours’ – complex behaviours that have their roots in experienced adversity. From our findings it would suggest that future ways to increase attendance should focus on positive strategies to support patient’s attendance.”

Dr Ross McQueenie, also from Glasgow University, added: “Our results suggest that socioeconomically deprived patients living in more affluent areas might have particularly high levels of unmet health need in primary care settings.”

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